Video: Does Your Prostate Size Matter? | Mark Moyad, MD MPH & Mark Scholz, MD
2019 Prostate Cancer Conference Excerpts | Transcription
Dr. Scholz: So, everyone wants to try and squeeze PSA into something it isn't. It's a very non-specific test and they've looked at rates of rise and all kinds of different algorithms which really don't add much more than just knowing the number. We've learned that PSA is useful if it's from 1 to 10, 10 to 20, or 20 and above. That's pretty crude. I mean, so these numbers where it goes from 6 to 7 and 5 to 3, unfortunately, don't translate into useful information. The only thing that has been shown useful is to compare it to the size of the prostate, called the PSA density—that's what Mark's talking about. You can't compare it to the size of the prostate if you don't know the size of the prostate. So, we see patients that—largest prostate in my—the winner in my practice right now is 350cc. Alright, I've got about five guys over 200cc and that's big because the average is 30cc-40cc, alright. So you're looking at almost 10 times bigger than normal.
Dr. Moyad: Yeah, because the average size is a walnut and that's a watermelon.
It's not really a watermelon. I just did that for drama, but it's huge.
Dr. Scholz: No, it's only a grapefruit.
Dr. Moyad: I know, but…
Dr. Scholz: So, the point is these gentlemen, most of them have come to the office. They've been biopsied like 5 to 10 to 15 times because everyone is so terrified that they have cancer. Over and over and over the biopsies are clear, they just have a giant prostate because their PSA is running 10 to 15 to 20 and they don't have cancer. Mark, so you say, they could have been spared all those biopsies if someone had just measured the size of the gland and put the PSA into context.
Dr. Moyad: You're damn right. Because the number one reason a PSA goes up in America and around the world today is because the prostate gets bigger, not because of cancer. So, you have to differentiate what's going on, and by knowing the size, you can level the playing field.
The other way you level the playing field, and I know I sound like a broken record, year after year, is that if you don't take care of yourself then they're gonna think that the rising PSA must be due to cancer. I can't emphasize that enough. So when someone is gaining weight and their blood sugar is going up, so is their blood pressure, all these things are happening, it can actually make the prostate bigger. The prostate doesn't like to be heart unhealthy. If you are heart unhealthy, the prostate responds in many men by getting bigger.
So, it's a cruel joke that God plays on men as you age. The only thing that really gets bigger on your body are bellies and prostate. But you've got to go against that, so what happens is, when you take care of yourself, it's the ultimate truth serum as to what is really going on here. So what happens all the time, I see, because I'm subject to this, but I wish this was standard is a guy starts taking care of himself with a rising PSA and they can't tell if it's BPH or not. And then the PSA starts to plummet as he loses weight. So what was happening was his prostate was getting bigger and bigger and then it either relaxed or started to shrink a little bit and they still can't find a tumor and then the PSA stabilizes and he's okay.
So I wonder about these guys who never get the opportunity to make that lifestyle change. You know, we talk about prevention, but it's so amazing. If I stood up to you and I said, "When diet and exercise doesn't work, there's Lipitor!" You would go, "Oh yeah, I know that. That's true, there's Lipitor. That's a statin." But let me tell you this. For the rest of your life, I want you to remember this: "When diet and exercise doesn't work, there's Proscar. When diet and exercise doesn't work, there's Viagra! When diet and exercise doesn't work, there's Vesicare!" It's true of everything! "When diet and exercise doesn't work, there's Fosamax for your bones!" It's true for everything. It's not just "when diet and exercise doesn't work we have a drug for you." So we have to find out what diet and exercise is going to do. Whether it's for your hot flashes, whether it's for your bone loss, whether it's for your rising PSA because your prostate is getting too big. So this is a really critical point. I mean, how many guys do you know can tell you the exact size of their prostate?
Dr. Scholz: And, of course, I'm surrounded by a lot of savvy patients, but I'm going to guess less than 10%.